Lack of Support For a Mother's Postpartum Experience

FASCINATING SURVEY THAT THE CHILDBIRTH CONNECTION PROMOTES

The postpartum experience of new mothers runs the gamut and often with little or no support. Welcome to the Clinician's Roundtable on ReachMD, The Channel for Medical Professionals. I am Bruce Japsen, the healthcare reporter for the Chicago Tribune and with me today is Maureen Corry. She is the Executive Director of the Childbirth Connection. In her role, Ms. Corry leads a National Not-For-Profit Organization founded in 1918 as Maternity Center Association. At Childbirth Connection, the group promotes safe, effective, and satisfying evidence-based maternity care and is the voice for the needs and interest of childbearing families. She has 30 years experience as a researcher, educator, advocate on maternal and infant health promotion in maternity care quality improvement. She joined Childbirth Connection as Executive Director in 1995, and has played a leading role in positioning the organization as a powerful and effective advocate for improving the quality of maternity care.

BRUCE JAPSEN:

Maureen Corry, welcome to ReachMD.

MAUREEN CORRY:

Thank you Bruce. It's a pleasure to be with you.

BRUCE JAPSEN:

So, the Childbirth Connection is based in New York, you join us today from New York. Tell us a little bit about the Childbirth Connection and this new survey you have of mothers that medical professionals will find very interesting.

MAUREEN CORRY:

Childbirth Connection was founded as you said in 1918 in New York City and for the past 90 years, actually this is our 90th anniversary year in 2008, we have been working to improve the quality of maternity care in a variety of ways. We are probably most well known for creating prenatal care back in 1918 and showing that prenatal care and education did in fact reduce maternal and infant mortality. We trained public health nurses across the country in maternal child health nursing. We brought the model of certified nurse midwifery care over from the United Kingdom and started the first school of nurse midwifery in the US. We established the American College of Nurse Midwives. We fostered the development of childbirth education in our country, and in 1975, we opened up the country's first urban free standing birth center in New York City, which we ran for 25 years and at that time the board decided it was a good time to transition out of direct care into other strategies to improve care and that’s when I joined the organization, and since then we have developed and had been implementing our program to promote evidence-based maternity care. What we found at that time Bruce was that no one in the US had done a survey of women's childbearing experiences. There is a lot of data and information available through many sources including the public health service, but we wanted to go directly to women to find out what their experiences were all about. So, we conducted the first national survey of women's childbearing experiences in 2002 and that survey was called listening to mothers and then we repeated that listening to mothers' survey in 2006 that was called listening to mothers II and then 6 months after the listening to mothers II survey, we went back to the same mothers to do a more in-depth survey of what happens in the postpartum period, which is basically the results that we are going to talk about today. So, overall we have a panoramic view of women's experiences before pregnancy in many cases up to 18 months after they gave birth.

BRUCE JAPSEN:

And what are some of the most telling results you found in this recent survey because it really is surprising, and I am sure our listeners would find that there have not been a lot of surveys in this area.

MAUREEN CORRY:

Yeah, it was really surprising to us. I am sure it will be to others as well. These reports are so extensive. It's really difficult to say, you know, some of the most important findings because everything seems important to us, but I guess what I could say overall Bruce is that the new mothers speak out survey clarifies that new mothers faced a broad range of physical and emotional health and work place challenges with little or no support after they gave birth and the good news is that the survey results really identify many opportunities to improve the circumstances for this large population of women and their babies during a really, really crucial time in the lives of them and their babies and their families and there are more than 4.3 million birth each year in the United States. So this is really a large population of women and babies that we were talking about and the implications are quite wide.

BRUCE JAPSEN:

And so in what specific areas are they not getting support, is it from their healthcare provider, is it their husband or spouse, zeroing in a little bit for our listeners on that.

MAUREEN CORRY:

Perhaps, I will start with the physical and mental health aspects of the postpartum period if that's okay with you. Overall, the good news was that the mothers gave high ratings to the health of their babies, but they identified many, many concerns about their own well-being. For example, we asked women about 15 specific health problems and if they were experiencing them as a new problem during the first 2 months of birth and then later on when we did the second survey and about 25% of the mothers reported that they were experiencing health problems that were new. In order words, they hadn’t had them before they were pregnant or gave birth and some of these women continued to experience problems from as long as 16 to 18 months after birth. For example, they experienced problems such as stress about 43%, weight control issues, weight loss, lack of sexual desire, physical exhaustion, backache, and one real concerning problem was pain at the incision site, 18% of mothers who had had a cesarean were still experiencing pain at the site of the incision as many as 16 to 18 months after birth.

BRUCE JAPSEN:

That's very interesting. On the front of bringing these issues to the fore are you finding that the healthcare providers are addressing these issues or are they happy to have this data, I am assuming it would help them.

MAUREEN CORRY:

Yes, it's really important to get the data out to providers because I think you know traditionally in our maternity care system postpartum care ends at the 6-week postpartum visit, but what this survey shows Bruce is that women are continuing to, you know, experience physical and emotional health problems way beyond that 6-week period. So, clearly we need to do more to help women who are having physical and emotional problems beyond the 6-week visit and what we found is that many women unfortunately don’t seek care beyond having infections, which we all know when we have an infection, we know it's important to get to a doctor, but for a lot of the other experiences including the emotional mental health issues, the majority of women were not seeing a provider and that's really of great concern because for obvious reasons.

BRUCE JAPSEN:

Well, if you are just joining us or even if you are new to our channel, you are listening to the Clinician's Roundtable on ReachMD, The Channel for Medical Professionals. I am Bruce Japsen, your host. I am with the Chicago Tribune and joining me today from New York City is our guest, Maureen Corry. She is the Executive Director of the Childbirth Connection and we are talking about a fascinating survey that the Childbirth Connection promotes. It is called listening to mothers postpartum survey.

We were just talking about how a lot of postpartum care traditionally from mothers out there ends after 6 weeks and what Maureen is telling us is that there are many, many issues that continue after this that are not being addressed and it's the women themselves as well as the providers here isn't it that are being challenged in this issue to get their care and have these things addressed.

MAUREEN CORRY:

Exactly and it's really, I think, the more providers know about what women aren't traditionally telling them or seeking care for the better they will be able to serve their clients, their patients especially when women do come to their offices to see them, it's really important to be aware of all these potential problems. I would like to go back for a minute if I might to talk a little bit about the mental health findings.

BRUCE JAPSEN:

Yeah, that seems to be one of the issues that often comes up with women, I wish you would do that.

MAUREEN CORRY:

Okay, well, Bruce, we use validated mental health screening tools on the survey and we found that around the time of the followup surveys most mothers were likely to be experiencing some degree of depressive symptoms. An 18% appeared to be experiencing some symptoms of posttraumatic stress with reference to their childbirth experience. So that was of deep concern that so many women are having these emotional health problems and we found that about 3 in 4 mothers with depressive symptoms and 3 in 5 mothers with notable symptoms of posttraumatic stress had not consulted a professional about their mental health challenges since giving birth.

BRUCE JAPSEN:

And how long does this last, this type of stress?

MAUREEN CORRY:

Well, it depends on the woman. As I said the survey went out as far as 6 to 18 months after the birth of the baby, so we would only know as far as 18 months for the percentage of women in this particular survey that were experiencing those problems.

BRUCE JAPSEN:

And it certainly lasted for that long for some.

MAUREEN CORRY:

For some it did, yeah, and actually, The Wall Street Journal did a major story on the mental health results of the survey and we really got a lot of pick up across the country on it, because it was very disconcerting to see the results.

BRUCE JAPSEN:

And what are people doing to address these issues. Is this being addressed by some of the obstetrics groups out there, is it coming to the forum and arena, are doctors surprised by these results?

MAUREEN CORRY:

I am not sure they would be surprised by the results mainly to the great extent, but I think that many physicians and midwives who provide maternity care to women across the country and also family physicians, you know, are aware that mental health problems exist and I think do some screening at least ask a woman if she is experiencing these problems, but I don’t think it's 100% of the time and really it's so important that screening be conducted by the health professional at the time of the visit because it's an opportune time to identify patients or women consumers with problems and then try to intervene with some you know positive strategies to help them get through this dangerous time in their lives.

BRUCE JAPSEN:

And where could a physician or a mother listening in, where could they turn to more information about this, I know your web site is www.childbirthconnection.org, are there things that they could turn to on that for more assistance in reading about these things.

MAUREEN CORRY:

I wish I could say that we have a large section of information on this topic on our site. We have information on listening to mothers and the postpartum mothers survey results, but I would recommend that they go to Postpartum Support International, which is a Not-For-Profit Organization. I believe their URL is www.psi.org, but that's a really excellent trustworthy site for information about the varying forms of mental health issues that women experience before and during birth.

BRUCE JAPSEN:

Have there been any studies of these women when they do seek medical help? Is it addressed and are they helped?

MAUREEN CORRY:

Oh, yes. Very much so. You know, I can't quote the latest research, but I think there is some data out there that supports use of drugs when necessary, medications, and also therapy as well and again Postpartum Support International really does a good job of discussing these issues about identification, screening, and treatment of mental health issues.

BRUCE JAPSEN:

Well, with that I would like to thank Maureen Corry, who has been our guest. She is the Executive Director of the Childbirth Connection, which she joined us from New York today. We have been talking to a new survey called listening to mothers, a postpartum survey, which is highlighting a very important and unfortunate problem that nearly 1 in 5 mothers suffer from posttraumatic stress after childbirth.

My name is Bruce Japsen. I have been your host and with the Chicago Tribune. I would like to thank Maureen Corry of the Childbirth Connection who has been our guest and I would like to thank you today for listening.

You are listening to ReachMD XM 160, The Channel for Medical Professionals.